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中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (05) : 262 -266. doi: 10.3877/cma.j.issn.1674-6899.2024.05.002

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妊娠期单孔腹腔镜手术实施行与思
徐敬云1, 丁波1, 蒋宇慧2, 沈杨1,()   
  1. 1.210009 江苏,东南大学附属中大医院妇产科
    2.210009 江苏,东南大学医学院
  • 收稿日期:2024-01-06 出版日期:2024-10-30
  • 通信作者: 沈杨

The practice and consideration of single-site laparoscopic operation during pregnancy

Jingyun Xu1, Bo Ding1, Yuhui Jiang2, Yang Shen1,()   

  1. 1.Department of Gynecology,Zhongda Hospital Affiliated to Southeast University,Jiangsu 210009,China
    2.Southeast University School of Medicine,Jiangsu 210009,China
  • Received:2024-01-06 Published:2024-10-30
  • Corresponding author: Yang Shen
引用本文:

徐敬云, 丁波, 蒋宇慧, 沈杨. 妊娠期单孔腹腔镜手术实施行与思[J]. 中华腔镜外科杂志(电子版), 2024, 17(05): 262-266.

Jingyun Xu, Bo Ding, Yuhui Jiang, Yang Shen. The practice and consideration of single-site laparoscopic operation during pregnancy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(05): 262-266.

妊娠期约有1/500 的孕妇需接受非产科因素的腹部手术。 以前,妊娠期间更倾向于开放手术。 随着腹腔镜设备的发展和手术技术的进步,腹腔镜作为一种安全、微创的方法被推荐用于妊娠期腹部手术。 单孔腹腔镜手术(laparoendoscopic single-site surgery, LESS)是一种通过单切口进行的微创手术技术,已广泛应用于包括妇科在内的许多领域。 妊娠期间,LESS 比多孔腹腔镜有几个优点,如切口小、美容效果好、术后疼痛少、恢复快等。 几项研究已证实了妊娠期LESS 手术的安全性和可行性。 妊娠期急腹症、潜在恶性或恶性附件肿物、持续良性附件肿物并有增大趋势的患者需要手术治疗,建议在妊娠中期进行手术。 通过38 例妊娠期LESS 治疗附件包块的手术,本团队总结了妊娠期LESS 的手术技巧及注意事项等。 总之,妊娠期由经验丰富的医师实施LESS 似乎是一种安全可行的方法。

Non-obstetrical abdominal surgery is required in approximately 1 in 500 pregnant women.Previously, open surgery was preferred during pregnancy. With the development of laparoscopic devices and improved surgical techniques, laparoscopy has been recommended as a safe, minimally invasive approach for abdominal surgery throughout pregnancy. Laparoendoscopic single-site surgery (LESS) is a minimally invasive surgical technique via a single incision, which has been widely used in many fields including gynecologic surgery. Several advantages of LESS over multiport laparoscopy during pregnancy have been indicated, such as the advantages of less incision, good cosmetic effect, less postoperative pain and quick recovery. Several studies have confirmed the safety and feasibility of LESS surgery in pregnancy. Patients with acute abdomen during pregnancy, potentially malignant or malignant adnexal masses, and persistent benign adnexal masses with a tendency to increase in size require surgical treatment, non-emergency surgery is recommended for the second trimester of pregnancy. Based on 38 pregnant women with adnexal masses who underwent LESS surgery, our team summarize the operative skills and precautions of monopole laparoscopy during pregnancy. In conclusion, LESS administered by an experienced physician during pregnancy seems to be a safe and feasible approach.

1
Pearl JP, Price RR, Tonkin AE, et al. SAGES guidelines for the use of laparoscopy during pregnancy[J]. Surg Endosc, 2017, 31(10):3767-3782.
2
Zachariah SK, Fenn M, Jacob K, et al. Management of acute abdomen in pregnancy: current perspectives[J]. Int J Womens Health, 2019, 11:119-134.
3
Cathcart AM, Nezhat FR, Emerson J, et al. Adnexal masses during pregnancy: diagnosis, treatment, and prognosis[J]. Am J Obstet Gynecol, 2023, 228(6):601-612.
4
Naqvi M, Kaimal A. Adnexal masses in pregnancy[J]. Clin Obstet Gynecol, 2015, 58(1):93-101.
5
Oguri H, Taniguchi K, Fukaya T. Gasless laparoscopic management of ovarian cysts during pregnancy[J]. Int J Gynaecol Obstet, 2005,91(3):258-259.
6
Phupong V, Bunyavejchewin S. Gasless laparoscopic surgery for ovarian cyst in a second trimester pregnant patient with a ventricular septal defect[J]. Surg Laparosc Endosc Percutan Tech, 2007, 17(6):565-567.
7
Schreiber JH. Laparoscopic appendectomy in pregnancy[J]. Surg Endosc, 1990, 4(2):100-102.
8
Ball E, Waters N, Cooper N, et al. Evidence-based guideline on laparoscopy in pregnancy: commissioned by the British Society for Gynaecological Endoscopy (BSGE) endorsed by the Royal College of Obstetricians & Gynaecologists (RCOG)[J]. Facts Views Vis Obgyn, 2019, 11(1):5-25.
9
ACOG committee opinion No. 775 summary: nonobstetric surgery during pregnancy[J]. Obstet Gynecol, 2019, 133(4):844-845.
10
Cox TC, Huntington CR, Blair LJ, et al. Laparoscopic appendectomy and cholecystectomy versus open: a study in 1999 pregnant patients[J]. Surg Endosc, 2016, 30(2):593-602.
11
Pearl J, Price R, Richardson W, et al. Guidelines for diagnosis,treatment, and use of laparoscopy for surgical problems during pregnancy[J]. Surg Endosc, 2011, 25(11):3479-3492.
12
Koo YJ, Kim HJ, Lim KT, et al. Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy[J]. Aust N Z J Obstet Gynaecol, 2012, 52(1):34-38.
13
Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease [ J]. Cochrane Database Syst Rev, 2009(3):Cd003677.
14
Cagino K, Li X, Thomas C, et al. Surgical management of adnexal masses in pregnancy: a systematic review and meta-analysis[J]. J Minim Invasive Gynecol, 2021, 28(6):1171-1182.e1172.
15
徐敬云, 杨鑫, 丁波, 等. 单孔腹腔镜腹股沟淋巴结清扫术在原发性阴道癌中的应用[J/CD]. 中华腔镜外科杂志(电子版),2018, 11(5):281-285.
16
杨鑫, 沈杨, 徐敬云, 等. 经脐单孔腹腔镜在不同类型全子宫切除术应用[J/CD]. 中华腔镜外科杂志(电子版), 2020, 13(5):274-277.
17
Bedaiwy MA, Farghaly T, Hurd W, et al. Laparoendoscopic singlesite surgery for management of ovarian endometriomas[J]. JSLS,2014, 18(2):191-196.
18
Podolsky ER, Rottman SJ, Poblete H, et al. Single port access(SPA) cholecystectomy: a completely transumbilical approach[J].J Laparoendosc Adv Surg Tech A, 2009, 19(2):219-222.
19
Kliethermes C, Blazek K, Ali K, et al. Postoperative pain after single-site versus multiport hysterectomy[J]. JSLS, 2017, 21(4).
20
Scheib SA, Jones HH, Boruta DM, et al. Laparoendoscopic single site surgery for management of adnexal masses in pregnancy: case series[J]. J Minim Invasive Gynecol, 2013, 20(5):701-707.
21
Yin M, Yang J, Zhou H, et al. Laparoendoscopic single-site surgery for adnexal disease during pregnancy: a single-center preliminary experience[J]. Front Surg, 2022, 9:994360.
22
Xiao J,Fu K,Duan K,et al.Pregnancy-preserving laparoendoscopic single-site surgery for gynecologic disease: a case series[J]. J Minim Invasive Gynecol, 2020, 27(7):1588-1597.
23
Jiang D, Yang Y, Zhang X, et al. Laparoendoscopic single-site compared with conventional laparoscopic surgery for gynaecological acute abdomen in pregnant women[J]. J Int Med Res, 2021, 49(10):3000605211053985.
24
Lee JH, Lee JR, Jee BC, et al. Safety and feasibility of a singleport laparoscopic adnexal surgery during pregnancy[J]. J Minim Invasive Gynecol, 2013, 20(6):864-870.
25
Upadhyay A, Stanten S, Kazantsev G, et al. Laparoscopic management of a nonobstetric emergency in the third trimester of pregnancy[J]. Surg Endosc, 2007, 21(8):1344-1348.
26
Guan Z, Wang K, Ma Y, et al. Laparoscopic single-site “in-bag”ovarian dermoid cystectomy in a 16-week- pregnant patient[J]. J Minim Invasive Gynecol, 2021, 28(9):1569-1570.
27
Jiang Y, Ding B, Huang H, et al. Application of transumbilical single port laparoscopic surgery for adnexal masses in pregnancy[J]. Asian J Endosc Surg, 2023,17(1): e13265.
28
Michos G, Dagklis T, Papanikolaou E, et al. Laparoscopy in pregnancy: a comparative review of national guidelines[J]. Cureus,2023, 15(5):e38904.
29
Chung MK, Chung RP. Laparoscopic extracorporeal oophorectomy and ovarian cystectomy in second trimester pregnant obese patients[J]. JSLS, 2001, 5(3):273-277.
30
Sandberg EM, la Chapelle CF, van den Tweel MM, et al.Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis[J]. Arch Gynecol Obstet, 2017, 295(5):1089-1103.
31
Kim WC, Lee JE, Kwon YS, et al. Laparoendoscopic single-site surgery (LESS) for adnexal tumors: one surgeon's initial experience over a one-year period[J]. Eur J Obstet Gynecol Reprod Biol,2011, 158(2):265-268.
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